title: Effect of endoscopic brow lift on contractures and synkinesis of the facial muscles in patients with a regenerated postparalytic facial nerve syndrome.
abstract: BACKGROUND
  Delayed recovery after facial palsy results in aberrant nerve regeneration with symptomatic movement disorders, summarized as the postparalytic facial nerve syndrome. The authors present an alternative surgical approach for improvement of periocular movement disorders in patients with postparalytic facial nerve syndrome. The authors proposed that endoscopic brow lift leads to an improvement of periocular movement disorders by reducing pathologically raised levels of afferent input.
  
  
  METHODS
  Eleven patients (seven women and four men) with a mean age of 54 years (range, 33 to 85 years) and with postparalytic facial nerve syndrome underwent endoscopic brow lift under general anesthesia. Patients' preoperative condition was compared with their postoperative condition using a retrospective questionnaire. Subjects were also asked to compare the therapeutic effectiveness of endoscopic brow lift and botulinum toxin type A.
  
  
  RESULTS
  Mean follow-up was 52 months (range, 22 to 83 months). No intraoperative or postoperative complications occurred. During follow-up, patients and physicians observed an improvement of periorbital contractures and oculofacial synkinesis. Scores on quality of life improved significantly after endoscopic brow lift. Best results were obtained when botulinum toxin type A was adjoined after the endoscopic brow lift. Patients described a cumulative therapeutic effect.
  
  
  CONCLUSIONS
  These findings suggest endoscopic brow lift as a promising additional treatment modality for the treatment of periocular postparalytic facial nerve syndrome-related symptoms, leading to an improved quality of life. Even though further prospective investigation is needed, a combination of endoscopic brow lift and postsurgical botulinum toxin type A administration could become a new therapeutic standard.
authors.affiliation: Wiesbaden, Germany; Zeist, The Netherlands; and Baltimore, Md. From the Department of Otorhinolaryngology-Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Dr. Horst-Schmidt-Kliniken; the Department of Otolaryngology-Head and Neck Surgery, Center for Facial Plastic Reconstructive Surgery, Diakonessen Hospital Zeist; and the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine.
authors.forename: Gregor M
authors.initials: GM
authors.lastname: Bran
authors.forename: Pontus K E
authors.initials: PKE
authors.lastname: Börjesson
authors.forename: Kofi D
authors.initials: KD
authors.lastname: Boahene
authors.forename: Jan
authors.initials: J
authors.lastname: Gosepath
authors.forename: Peter J F M
authors.initials: PJFM
authors.lastname: Lohuis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D003286:Contracture / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005152:Facial Muscles / Q000294:innervation / Q000601:surgery; D005155:Facial Nerve Diseases / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D005158:Facial Paralysis / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005546:Forehead / Q000294:innervation / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009416:Nerve Regeneration; D009465:Neuromuscular Agents / Q000627:therapeutic use; D011446:Prospective Studies; D012189:Retrospective Studies; D046608:Synkinesis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A